Monday, April 2, 2012


     It was 9am and my cell phone rang. Very few people , other than most of the physicians , know my cell phone number. In spite of the lack of the caller ID I decided , I did pick it up . It was one of my Friends or the aquatints that was calling me . He wanted me to see his son . His son was sick and was taken to one of the ERs and was discharged home with the diagnosis of 'dehydration ' . I am not an internist, and normally evaluate patients with pulmonary problems only . But with this 'friend calling me , to his own 'son ' , I could not say 'no' . I my schedule was full, so I told him to bring him to my office at 4-15 pm . and also told him to bring as much as possible information or records from the emergency room .
       I was so busy that I had forgotten about the conversation , till he showed up . He was my last patient. The father and the son were in the examination room , when I entered it . I knew the brief story . But I asked him anyway . The son was 25 years old , and went to supermarket , did the shopping and came out . He did not feel good, so sat on the bench outside. And then passed out . Someone noticed it and 911 was called and he was taken to the local emergency room . In the ER they did cardiogram, did blood tests, including blood tests to rule out heart attack( mind you in this 25 years old patient ) and test to rule out 'drugs ' . All the blood tests were normal. So they told him " you are dehydrated " and gave him intravenous fluid .
    As a lung doctor I was not too sure what I could do in the morning and now in spite of the story and the labs , cardiogram  etc  I was not sure if I knew what was the cause of the him passing out. But I had to know . The rare possibility of increased pressure in the lung circulation called  pulmonary hypertension did cross my mind and I was going to do the work up to rule it out , but that was my last choice as there was no history suggestive of it . I was sitting facing the patient and I thought that he was shifting the position little too frequently and may looked little uncomfortable.( or may be I was grasping for the straw). So I asked him if there was any problem . H e said no , but when I asked him if he was 'hurting ' , he answered 'yes --a little bit ' . So I told  the father to step out. I told him to pull the pants down and show me where he was hurting. And I got my answer. HE HAD SWELLING IN THE UPPER PART OF TESTICLE , he had what I thought was  epididymitis .
     I called the father in the room , told my findings and told him that due to the significant sudden pain when he sat down , he passed , what we call 'vaso vagal response '. ( due to pain a vagus nerve is stimulated which causes drop in the heart rate and the blood pressure which in turn causes passing out ).
   I called local radiology clinic to a 'stat ' ultrasound ' of the testicle and call me with the report. and call a urologist to see him in the morning , gave him an antibiotics.
    There was no testicular twisting and my hunch was correct , HE DID FINE.

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